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The costs, coverage, and statistics that matter for Americans with kidney disease — Medicare ESRD rules, dialysis pricing, survival data, and provider comparisons. Every figure from the federal registries (USRDS, CDC, CMS).
If you have kidney failure, Medicare covers dialysis and transplant — even if you're under 65. The ESRD entitlement is unique: kidney failure is one of only two conditions that qualify you for Medicare regardless of age.
Read the guideDialysis costs roughly $90,000 per patient per year in the US — Medicare spends about $100,000 per dialysis patient annually. Per-session costs run $250-500. Costs differ sharply by modality: home dialysis and transplants cost less and pay better outcomes.
Read the guideAbout half of US dialysis patients are alive 5 years after starting treatment — but that average hides enormous variation. A 30-year-old on dialysis has a much better outlook than an 85-year-old, and transplant survival is roughly 2-3× better at every age.
Read the guideDaVita and Fresenius together operate about 5,500 of America's ~7,500 dialysis centers — roughly 73% of the market. Both offer in-center hemodialysis, peritoneal dialysis, and home training. This comparison uses the official CMS facility registry for real counts.
Read the guideHome hemodialysis offers more frequent or longer sessions, better blood pressure control, and lower annual cost than in-center care — but it needs a care partner, training, and space. In-center care offers staff supervision and social support. Both are valid; the best choice is the one that fits your life and medical situation.
Read the guideA kidney transplant costs roughly $400,000 in the first year (surgery, hospitalization, induction drugs) and about $25,000 per year afterward for immunosuppression and follow-up. Medicare covers the transplant for ESRD patients — including lifelong anti-rejection drugs since 2000.
Read the guideKidney disease changes insurance in predictable ways: employer plans pay first for 30 months after ESRD entitlement, then Medicare takes over. Marketplace, Medicaid, and COBRA all have specific ESRD rules. The key is planning the transition — not winging it.
Read the guideAbout 1 in 7 US adults — 35.5 million people — has chronic kidney disease, and most don't know it. Nearly 810,000 have kidney failure, with 560,000 on dialysis. Diabetes and hypertension cause two-thirds of cases.
Read the guideMedicare covers dialysis, but 'covered' doesn't mean free. You'll typically pay Part A/B deductibles and 20% coinsurance — with no annual cap in Original Medicare. Medigap or Medicare Advantage changes that picture, and the ESRD rules differ from standard Medicare.
Read the guideChoosing a dialysis center is a quality, logistics, and fit decision. CMS publishes star ratings and quality measures (patient survival, infection ratios, Kt/V adequacy, catheter use) for every Medicare-certified center — pair those with location, PD/home options, and a facility visit.
Read the guideThe first year on dialysis is a steep learning curve: vascular access, a 3x/week schedule, diet and fluid rules, medications, and the emotional and practical adjustments. This guide maps what to expect and how to build a sustainable routine.
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This content is a general reference, not medical advice, a diagnosis, or a treatment plan. Do not change your diet, fluids, medicines, or dialysis plan without your nephrologist or renal dietitian. Individual recommendations depend on your labs, medications, conditions, and care plan.